Tumor to cervical spinal cord standardized uptake ratio (SUR) improves the reproducibility of <sup>18</sup>F-FDG-PET based tumor segmentation in head and neck squamous cell carcinoma in a multicenter setting.
van den Bosch, S
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<h4>Background</h4>In quantitative FDG-PET data analysis, normalization of the standardized uptake value (SUV) with an internal image-derived standard improves its reproducibility. In this study, the cervical spinal cord is proposed as an internal standard that is within the field of view of the radiotherapy planning PET/CT-scan in head and neck cancer. The aim is to evaluate if the tumor to cervical spinal cord standardized uptake ratio (SUR) can improve the reproducibility of a model to determine the metabolic tumor volume (MTV) on FDG-PET/CT in a multicenter setting.<h4>Materials and methods</h4>Ninety-five radiotherapy planning FDG-PET/CT-scans of patients with head and neck cancer were analyzed using the Bland-Altman method to evaluate differences in FDG-uptake in the cervical spinal cord and the mediastinal blood pool. Non-linear regression analysis was used to determine the optimal MTV using the gross tumor volume (GTV) as ground truth and a spatial overlap-index as statistical validation metric. Reproducibility was evaluated using the Bland-Altman method and external validation was performed in an independent dataset consisting of 62 patients.<h4>Results</h4>Bland-Altman's analyses demonstrated equivalence of FDG-uptake in the mediastinal blood pool and the cervical spinal cord. Reproducibility of the models improved when using SUR instead of SUV. These results were confirmed in the validation cohort.<h4>Conclusion</h4>The use of the tumor to cervical spinal cord SUR instead of SUV improves the reproducibility of a model to determine the MTV on FDG-PET/CT in a multicenter setting. This study indicates that SUR may be preferred over SUV based approaches.
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Head and Neck Neoplasms
Radiotherapy Planning, Computer-Assisted
Reproducibility of Results
Positron Emission Tomography Computed Tomography
Squamous Cell Carcinoma of Head and Neck
Translational Molecular Imaging
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Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2019, 130 pp. 39 - 45